title: The costs and utility of imaging in evaluating dizzy patients in the emergency room.
abstract: OBJECTIVE
  To determine the usefulness and the costs of computed tomography (CT) and magnetic resonance imaging (MRI) in the evaluation of patients with dizziness in the emergency department (ED).
  
  
  METHODS
  Retrospective chart review.
  
  
  METHODS
  Charts of patients with a specific health maintenance insurance plan presenting with dizziness and vertigo to a large health system's ED between January 2008 and January 2011 were reviewed. Patient demographics, signs/symptoms, and CT and MRI results were assessed. CT and MRI charges were determined based on positive versus unremarkable findings. Data analysis included stepwise logistic regressions.
  
  
  RESULTS
  Of 1681 patients identified, 810 (48%) received CT brain/head scan totaling $988,200 in charges. Of these, only 0.74% yielded clinically significant pathology requiring intervention. However, 12.2% of MRI studies yielded discovery of significant abnormalities. Logistic regression analysis revealed that older patients (P = .001) were more likely to receive a CT scan.
  
  
  CONCLUSIONS
  In the 3-year period studied, CT scans for ED patients with dizziness and vertigo yielded a low predictive value for significant pathology. These data reveal a great opportunity for cost savings by developing stricter guidelines for ordering CT scans for this set of ED patients. The use of MRI in all cases of dizziness was found to be neither practical nor useful. However, appropriately directed MRI of the brain is recommended in patients with dizziness and other neurological signs or symptoms.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Henry Ford Health System, Detroit, Michigan, U.S.A.
authors.forename: Syed F
authors.initials: SF
authors.lastname: Ahsan
authors.forename: Mausumi N
authors.initials: MN
authors.lastname: Syamal
authors.forename: Kathleen
authors.initials: K
authors.lastname: Yaremchuk
authors.forename: Edward
authors.initials: E
authors.lastname: Peterson
authors.forename: Michael
authors.initials: M
authors.lastname: Seidman
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D015331:Cohort Studies; D016208:Databases, Factual; D003937:Diagnosis, Differential; D003952:Diagnostic Imaging / Q000191:economics / Q000706:statistics & numerical data; D004244:Dizziness / Q000175:diagnosis* / Q000191:economics / Q000453:epidemiology; D004636:Emergency Service, Hospital / Q000191:economics* / Q000706:statistics & numerical data; D005260:Female; D017721:Hospital Costs; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008279:Magnetic Resonance Imaging / Q000191:economics* / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D059906:Neuroimaging / Q000191:economics / Q000706:statistics & numerical data; D012189:Retrospective Studies; D018570:Risk Assessment; D017678:Sex Distribution; D014057:Tomography, X-Ray Computed / Q000191:economics* / Q000706:statistics & numerical data; D014717:Vertigo / Q000175:diagnosis* / Q000191:economics / Q000453:epidemiology; D055815:Young Adult
keywords: Dizziness; computed tomography; cost savings; emergency room evaluations; magnetic resonance imaging; neurological signs and symptoms; vertigo